Pharmacy Closures in Rural America: A Looming Public Health Crisis
The closure of pharmacies across rural America is not just a matter of inconvenience; it is a slow-motion public health emergency. Families in underserved areas, like mine, rely on local pharmacies not only for medication but for survival. When my father needs insulin, he embarks on a 25-mile journey to the nearest Walgreens in a remote corner of California. This 50-minute trip is the only option for him to access his medication, a flu shot, or basic health advice.
Walgreens recently announced its plan to close 1,200 stores by 2027, further exacerbating the pharmacy desert crisis in America. These closures highlight an ethical failure where investor profits take precedence over the health and well-being of communities. To address this pressing issue, three urgent steps must be taken: supporting underserved areas with targeted incentives and innovative pharmacy services, investing in the pharmacy workforce through safe staffing practices, and granting pharmacists provider status with expanded scope of practice.
The United States has seen a significant decline in pharmacies, with over 26,000 closures between 2010 and 2021. Nearly 45 million Americans now live in pharmacy deserts, where the nearest pharmacy is more than 10 miles away. These closures disproportionately affect rural communities, low-income neighborhoods, and communities of color.
The root cause of these closures can be traced back to private equity firms like Sycamore Partners, whose profit-driven motives prioritize financial gain over patient care. As private equity continues to infiltrate the healthcare sector, closures become a common occurrence, depriving communities of vital healthcare services.
Pharmacies play a crucial role in our public health system, offering essential services such as flu shots, Covid-19 vaccines, and medication counseling. For many individuals without regular access to healthcare providers, pharmacies serve as the primary point of care.
Four main factors contribute to the crisis facing American pharmacies: a broken reimbursement model that favors pharmacy benefit managers (PBMs), a burned-out workforce experiencing high levels of stress and turnover, the creation of pharmacy deserts due to closures, and limitations on pharmacists’ scope of practice.
To combat this crisis, federal and state governments must intervene with grants, tax credits, and incentives to sustain pharmacies in underserved areas. Mobile and telepharmacy models can also help bridge the gap in regions where brick-and-mortar stores are not viable. Additionally, enforcing staffing ratios, establishing national training standards, and expanding pharmacists’ scope of practice are crucial steps towards addressing these challenges.
The closure of pharmacies like Walgreens and the bankruptcy of Rite Aid are not inevitable outcomes but rather deliberate business decisions. Each closure widens disparities, leaving patients without access to essential care and medications. It is imperative that we prioritize the well-being of communities over profits and take immediate action to prevent further harm.
If pharmacies continue to shutter their doors, the consequences will be dire. Patients like my father will face increased barriers to accessing vital medications, leading to missed doses and potential hospitalizations. The time to act is now, as the solutions to this crisis are clear and morally imperative.
Failure to address the pharmacy desert crisis is a choice to let vulnerable communities like my own suffer the consequences. As a just society, we must prioritize the health and well-being of all individuals, ensuring that no one is left behind in the pursuit of profits.
Guadalupe Hayes-Mota is the director of bioethics at Santa Clara University’s Markkula Center for Applied Ethics and a senior lecturer at MIT.
